Current diet trends which ones are best?

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2 Current diet trends which ones are best? Dietitian Caroline Clark Accredited Practising Dietitian Diabetes NSW

3 Can we say which diet is best? There is SO MUCH nutrition noise it can cloud judgement So how do nutrition experts decipher?

4 Aim: To have a quick look at a levels of evidence grading system, nutrition experts use to rate the safety of diets for people living with diabetes

5 Grade A = the conclusion is supported by GOOD evidence Results are from studies of strong research design for answering the practice question, clear methodology and sufficient sample size

6 Grade B = the conclusion is supported by FAIR evidence Results are from studies of strong research design with minor methodological concerns or inconsistencies or from studies of weaker designs but generally consistent results

7 Grade C = the conclusion is supported by LIMITED evidence Results are from studies of weak design or there is uncertainty due to inconsistencies among results

8 Grade D = a conclusion is not possible or extremely limited Evidence is unavailable and/or of poor quality and/or contradictory

9 Strong evidence is vital to ensure SAFE practise & advice

10 Lets look at a diets including a few on-trend diets How do these rate? and which diets are SAFE for People Living with Diabetes (PLWD)?

11 Low carb diet Main principles No single definition Range of diets comprising <45% daily calories form carbs Low carb, high protein (eg Atkins) Low carb, high fat etc. Most Australians are eating a moderate carb diet (~45% (~230g/d);NNS 2012) - PLWD; Carb 7% since 1995 (BMES)

12 Low carb diet The research Equivocal (+/-) results May show short term benefit but sustainability & adherence drop as restriction increases Low carb vs weight loss ADA and CDA: Insufficient evidence to set an ideal amount of carb intake for PLWD. Requirements needs to be individualised. The evidence: Grade C - D C= Conclusion is supported by LIMITED evidence; D= conclusion not possible or evidence is unavailable or of poor quality

13 Low carb diet Safe for people living with diabetes? Possibly - depending on level of restriction Ketogenic diets (<20-50g carb per day) NOT advisable Caution HYPO risk Potential for fibre & other nutrient deficiencies NB: Modern Day lower carb diets that focus on carb quality, less refined processed foods, increased plant foods, quality lean proteins may warrant consideration seek APD support

14 Paleo diet Main principles: Attempts to duplicate diet of early humans Palaeolithic era 2.5 million to 10,000 years ago Idea that we have not genetically adapted to agricultural foods (grains, dairy, legumes, refined and processed foods) No one single Paleo diet; True Paleo is not a carb free diet (ie evidence of grasses/grains & legumes consumption) Modern Paleo has many variations; No grains, legumes, dairy or sugar may incl. butter, paleo cupcakes Idea that modern chronic illness comes down to how we eat (no argument there)

15 Paleo diet The science: Some benefits shown in BP, cholesterol, TG, insulin sensitivity & weight Most of these benefits were NOT independent of weight loss Small studies, short term, conflicting results & poor methodology (some) There is no ONE Paleo diet varied widely depending on geography and season The evidence: Grade D D= conclusion not possible or evidence is unavailable or of poor quality

16 Paleo diet Safe for people living with diabetes? Possibly (Modified Paleo; less processed foods) Caution Lower carb intake and risk of HYPOs Nutrient deficiencies (ie Ca; NRV= mg/d) Long term effect of high protein diet (especially on renal system) is unknown Economic and environmental sustainability

17 5:2 diet Main principles: A version of intermittent fasting 5 days normal eating (eat what you like) 2 days fasting: non-consecutive days very restricted eating : Women = 500Cal/d (2100kJ/d) Men = 600Cal/d (2500kJ/d) Goal is weight loss 17

18 5:2 diet The science: Lack of quality longer term studies Some studies show slightly greater weight loss outcomes than more traditional daily calorie restriction? Total effect is due to calorie restriction Differing application of the diet makes it difficult to compare studies The evidence: Grade D D= conclusion not possible or evidence is unavailable or of poor quality

19 5:2 diet Safe for people living with diabetes? Possibly Caution dramatic carb qty change on fasting days = HYPO risk Health professional support advised

20 Mediterranean diet Main principles Modern take on traditional Mediterranean dietary patterns; no one type (Crete/Greece, Southern Italy and Spain) High intakes plant foods (olive oil, vegetables, legumes, wholegrains, nuts & fruits) Moderate intake of protein (white meats & fish, some red meat, some dairy & eggs)

21 Mediterranean diet The science: A significant number of high quality studies Consistent findings across studies Strong evidence The evidence: Grade A A= the conclusion is supported by GOOD evidence

22 Mediterranean diet Safe for people living with diabetes? Yes Is not restrictive or specialised and is modifiable Is sustainable (dietary & environmental) Consistently found to have benefits for diabetes beyond other diets (insulin resistance, HbA1C, plasma glucose, CVD)

23 Australian dietary guidelines Main principles: Advice about the amounts and kinds of foods that we need to eat for: Health and wellbeing Reducing the risk of chronic disease (Diabetes, CVD, obesity & cancer) 23

24 Australian dietary guidelines The science: Strong evidence >55,000 studies of high quality The evidence: Grade A A= The conclusion are supported by good evidence

25 Australian dietary guidelines Safe for people living with diabetes? Absolutely Is not restrictive or requiring specialised foods Is modifiable Culturally Economically Social and culinary preference

26 One size DOES NOT fit all Reducing HbA1C by % from*: Low carb Low GI High protein Mediterranean High carb vegetarian *systematic reviews/ meta-analyses Consider overall health/ nutritional fitness/ relationship with food

27 Common elements of diets Eat WHOLE FOODS; less processed & close to nature Limited refined starches, added sugars, processed foods; limited intake of certain fats; emphasis on whole plant foods, with or without lean meats, fish, poultry & seafood

28 You are an individual and the best eating pattern for you needs to be specific to your needs There are many roads to the destination of good health and optimal diabetes management An APD can tailor advice to what suits you with a focus on nutritional fitness

29 Thank you

30 Australian Diabetes Council trading as Diabetes NSW Questions and Discussion

31 Prognosis= a prediction of the probable outcome Prospective Study= looks at the relationship between a condition and a shared characteristic Intervention= a change to usual treatment The Conclusion is supported Cohort= a group by GOOD evidence Homogeneity= same Results are from Etiology= studies of strong research design for the answering cause the practice question, clear methodology and sufficient sample size RCT (Randomised Controlled Study) = a new treatment with people randomly assigned in different groups Bias= the distortion Meta Analysis= an analysis of all studies

32 Prospective Cohort= a study over time Prognosis= a prediction of the Intervention= a change to usual treatment Methodological= having a method The Conclusion is supported Etiology= cause by FAIR evidence Systematic Review= analysis of all research studies Clinically Significant = practical importance of use in daily life. probable outcome Results are from studies of strong research Bias= distortion Case Control studies = involves design with minor methodological concerns or individuals with and without a inconsistencies or from studies of weaker particular disease or condition designs but generally consistent results. RCT Heterogeneity=different (Randomised Controlled Study) =a Cohort Study= a new treatment with study of a group people randomly who share a Generalizability= assigned in different common can it be applied groups characteristic to the whole population

33 The conclusion is supported by LIMITED evidence Results are from studies of weak design or there is uncertainty due to inconsistencies among results

34 A conclusion is not possible or extremely limited due to unavailable evidence and/or poor quality evidence and/or contradictory evidence

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39 Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Smith GC 1, Pell JP. BMJ Dec 20;327(7429): OBJECTIVES: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. DESIGN: Systematic review of randomised controlled trials. STUDY SELECTION: Studies showing the effects of using a parachute during free fall. MAIN OUTCOME MEASURE: Death or major trauma, defined as an injury severity score > 15. RESULTS: We were unable to identify any randomised controlled trials of parachute intervention. CONCLUSIONS: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

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